BETTER care for the seriously ill outside hospitals is tipped to be part of a major health reform document to be released on Monday. Health Minister Nicola Roxon says the interim report from the Federal Government's National Health and Hospitals Reform Commission contains some "radical" ideas.

The Age believes such ideas include changing the balance between public and private treatment.
The report will examine the option of a single national health care system run out of Canberra. Some sources believe it will suggest replacing much of Medicare with a British-style "fund holding" model for GPs, in which particular regions or practices get a block grant to "ration" out to patients. That would attract fierce resistance, especially from doctors worried about mixing medical decisions with financial ones. The document will also look at building new bridges between health care in hospitals (mostly state funded) and in the community (mostly federa funded). "People want us to look at doing things in a different way, want access to services closer to their communities, want to find ways that they can have more continuous contact with health professionals throughout the course of their lives," Ms Roxon told The Age.

One such link is in palliative care, which deals with easing suffering, especially for patients with incurable disease. A community palliative care nurse told The Age the biggest barrier she faced was access to the Pharmaceutical Benefits Scheme. Nurse practitioner Leanne Davey has the power to write scripts for medication in the case that a severely ill patient's pain or nausea takes a sudden turn for the worse. But those scripts are not covered by the PBS, so the patient's family must pay the full cost. The alternative, going via a GP or specialist, can take more than a day. In some cases the patient must go back to hospital - a much more expensive and alienating environment. "I need to be able to get care to them promptly," Ms Davey said. "(Lack of PBS access) is a big constraint in many ways to us fulfilling our roles." Ms Roxon said the report had practical, immediate initiatives and longer-term ones for next year's budget or even the next election. Another source said aged care was a focus of the commission's report: removing the perverse incentives that keep nursing home patients in public hospitals.

Sceptics in Canberra wonder whether the federal budget has any room left for real reform. Australia's premier health economist, Dr Paul Gross, the director of the Institute of Health Economics, doubts there will be money left over for health given the amount just spent heading off economic disaster.
"I expect the report ... to be very, very general, with three or four key points that are 'light on the hill'," he said. "So while we go on writing general reports of wish lists, the really hard work is still ahead."

The commission's report will be released by commission chairwoman Christine Bennett at the National Press Club in Canberra on Monday.